A more severe and related condition is pubic symphysis diastasis
in which the pubic joint loosens and leaves an abnormally wide gap between the two pelvic bones. The increased motion at the pubic symphysis creates increased shearing forces which results in tissue inflammation and or pain.
Once again the hormone relaxin plays a significant role in mobility of the pubic symphysis and pelvic ligaments. Relaxin and progesterone increase the water content of the ligaments at about 12 weeks.
Some women experience severe pubic symphysis pain both during pregnancy and post-partum (after delivery). The physiological widening associated with pregnancy and delivery is small and asymptomatic and resolves within a few months of delivery.
Diagnosis of a pubic symphysis diastasis can be assisted by performing a Flamingo view X-ray. This requires an X-ray to be taken whilst standing on a single leg and measuring the degree of separation at the pubic symphysis – a comparison is made between the right and left single leg findings.
Examination and Treatment
- The patient presents with severe postpartum pain & disability, this may be following a first or subsequent pregnancies.
- Earlier pregnancies may have reported no symptoms or varying degrees of SIJ/pelvic, groin pain or pubic symphysis problems
- In very severe cases presents to the clinic wheel-chair bound or partial weight bearing with the use of crutches
- Reports great difficulty with standing or walking, often having to relocate to a downstairs level at home (stairs are impossible)
- Discomfort with sitting, side-lying positions, turning over in bed and reports a feeling of the pelvis/pubic bones “splitting open”
- Exhibit signs of general deconditioning from enforced bed-rest
Patients with pubic symphysis diastasis are poorly managed by the medical profession often told to: “just get on with it” or “things will never be the same”. They are unfortunately given a poor prognosis with little hope of any treatment when in fact positive outcomes are achievable if the appropriate intervention is provided.
How does Spinal Synergy Physiotherapy treat pubic symphysis problems?
Examination of the pubic symphysis takes place within a framework examining the entire lumbo-pelvic region and involves tests to assess mobility and stability of the pelvis (SIJ and pubic symphysis). The treatment model in this condition represents current knowledge and comes from anatomical and biomechanical studies of the pelvis and continues to evolve.
Any pelvic dysfunction at the pubic symphysis and sacroiliac joints must be addressed and needs to be assessed by a physiotherapist with specific skills in treating pubic diastasis problems. As with other pelvic related problems specific strapping or a pelvic stability belt can be used to provide compression and assist in stabilising the pelvis during activity. Specific exercise to facilitate core stability in non-weight bearing positions initially and then progressively retraining core stability and posture control into dynamic situations forms an essential part of the treatment package. This in time may be progressed into Pilates and other global strengthening type exercise programs.
Taso Lambridis has presented on pubic symphysis diastasis at the Australian Physiotherapy Association Conference in 2007 and is able to draw on a network of specialised doctors with an interest in this condition. Taso works closely with other physiotherapists who specialise in treating pelvic floor conditions who can provide further assistance for these conditions.